Recognition of bleeding
For minor bleeding (internal or latent), puncture (joint, pleural cavity, pericardium) is used. Endoscopic and radiological examinations provide great assistance in diagnosis. Bronchoscopy, thoracoscopy, esophagoscopy, gastroscopy, duodenoscopy, rectoromanoscopy, colonoscopy, laparoscopy, cystoscopy are widespread.
For the study of internal bleeding can be used radioisotope method. The radionuclide is injected intravenously and normally accumulates in the liver, where it is absorbed by reticuloendothelial cells and disappears from the bloodstream in 15-20 minutes. In pathology, it is found in the tissues or in the cavity along with the outflowing blood.
For latent bleeding in the gastrointestinal tract, a benzidine test is used.
Outcomes of bleeding: bleeding, leading to a rapid decrease in maximum blood pressure to 80 mm Hg. Art. or a fall in the percentage of hemoglobin by 1/3 of the initial values is extremely dangerous, since bleeding of the brain may develop. During a slow blood loss over several weeks, the body adapts to chronic anemia and there may be a long time with a very low hemoglobin content.
Blood poured into a closed cavity can squeeze the brain, heart, lung, etc., disrupt their activities and create a direct threat to life. Hemorrhages, squeezing blood vessels, nourishing tissues, sometimes lead to necrosis of the limb.
The blood circulating in the vessel is largely bactericidal, while poured into the tissues and cavities it becomes a good nutrient medium for microbes. Therefore, with internal or interstitial accumulations of blood, there is always a chance of infection. Thus, the development of pyogenic microflora in hemothorax causes purulent pleurisy, in hemarthrosis - purulent arthritis.
Without medical care, bleeding can result in spontaneous arrest or bleeding and death from brain anemia and impaired cardiovascular activity.
Spontaneous hemostasis. It occurs as a result of a spasm of a blood vessel and the formation of a blood clot in its lumen, which is facilitated by a decrease in blood pressure during bleeding.
If then purulent infection does not develop in the cavity (pleural, abdominal, etc.), the blood is destroyed and absorbed. With intracapital hematoma on the extremities as a result of the closure of the damaged vessel with a thrombus, blood circulation is usually restored through the collateral vessels, and the hematoma may gradually dissolve. Because of reactive inflammation, a connective tissue capsule is often formed around the blood, i.e. a blood cyst appears. Usually, scars and adhesions occur around it, and calcium salts are deposited in the capsule itself.
The mechanisms of blood loss compensation: for the outcome of bleeding, the magnitude and speed of blood loss, the age of the patient, the general condition of the body and the cardiovascular system are of great importance.
To maintain the necessary level of blood supply to the vital organs in the body, a complex adaptation mechanism develops, including: 1) vascular spasm; 2) increased heart rate and respiration; 3) an increase in the volume of circulating blood by attracting it from the depot and tissue fluid.
Profuse (massive) arterial bleeding leads to acute anemia so quickly that the mechanisms to compensate for blood loss do not have time to develop. And even mildly pronounced bleeding is the cause of death of the patient. The main work on the restoration of blood loss falls on the cardiovascular system. Therefore, in old age, when the heart and blood vessels no longer have sufficient reserves, worse outcomes are observed. Sclerosis, organic defects and functional disorders of cardiac activity are very unfavorable moments. Children of early age suffer bad blood loss, as they have not yet had time to form all the mechanisms of compensation. An important role is played by the biochemical properties of blood, in particular, the state of the coagulation system. In case of its violation, for example, of the streets suffering from hemophilia, even a minor injury can lead to acute anemia and death of the victim.
Methods to temporarily stop bleeding: lift the limb, bend as much as possible in the joint and squeeze the vessels passing in this area (finger pressing, pressure bandage, application of tourniquet, as well as clamps on the bleeding vessel in the wound). Existing methods have positive and negative sides and are used in isolation or in combination (for example, pressure bandage and elevated limb position). Any injury to a limb without clear signs of damage to a large artery serves as an indication for applying a pressure bandage. Its disadvantage is that it does not stop the bleeding from large arteries and, by squeezing the tissue, leads to impaired blood circulation in the peripheral parts of the limbs. Raising a limb high, you can stop the bleeding if the veins are damaged. This method is more often used in combination with a pressure bandage.
The pressing of the artery. It is used to temporarily stop arterial bleeding on the limbs, neck, head. The compression is made above the bleeding site, where there are no large muscle masses, where the artery is not very deep and can be pressed down to the bone. Pressing is done at certain points. The most important of them are: the inguinal fold - for the femoral artery, popliteal area - for the shank artery, elbow joint
- for the brachial artery in the elbow, the axillary region and the inner surface of the biceps muscle - for the artery of the arm; on the neck at the inner edge of the sternoclavicular muscle, near its middle - for the carotid artery, pressing it with the finger to the transverse process of the VI cervical vertebra. The subclavian artery is squeezed, pressing it to 1 edge at a point located above the collarbone, immediately outward from the site of attachment of the sternocleidomastoid muscle to the sternum handle. The axillary (axillary) artery can be squeezed by pressing it against the head of the humerus in the armpit. The brachial artery is pressed against the inner surface of the humerus at the inner edge of the biceps muscle. It is easiest to squeeze the femoral artery by pressing it against the horizontal branch of the pubic bone at a point that is located immediately below the pupartic ligament (in the inguinal region) midway between the anterior superior iliac axis and the symphysis (the bones).
Pressing the vessel with a finger can sometimes temporarily stop the bleeding and deliver the victim to the surgical department. Often, when a vessel is pressed, a large nerve trunks located nearby are squeezed with a finger, which causes severe pain. A prolonged stop of bleeding by this method is impossible.
Overlay harness. Circular pulling of the soft tissues of the limb along with blood vessels is carried out with a tourniquet. There are various modifications (harness with pilot, elastic, etc.). The Esmarch harness is a sturdy rubber tube with a length of up to 1.5 m, at one end of which a metal chain is fastened and at the other a hook. A rubber bandage injures tissue less than a rubber tube.
A raised limb is surrounded by a strongly stretched bundle 2-3 times higher than the injury site, after which it is tied or hooked to a chain. In order not to infringe on skin, a towel is placed under the rope. When the bundle is properly applied, arterial bleeding immediately stops, the pulse disappears and the limb turns pale (waxy look). Too much dragging can cause paralysis and death of the limb. A weakly imposed tourniquet squeezes only the veins, which leads to stagnation of blood in the limbs and increased bleeding. When only the veins are injured, a tourniquet is usually not required, since the bleeding can be stopped by applying a pressure bandage, lifting a limb and improving the outflow.
Disadvantages of imposing a tourniquet: 1. Compression of not only the arteries, but also the nerve trunks, which can lead to paresis. 2. The cessation of blood circulation in the tissues reduces their resistance to infection and creates a fertile ground for the development of anaerobic gangrene, 3. It is impossible to leave a burn on the limb for more than 2 hours due to the danger of necrosis. Therefore, the time of application of the harness should be reported to the accompanying patient.
To reduce the adverse effect, it is recommended that after one hour, dissolve the tourniquet for several minutes (if the bleeding does not resume) and then tighten it again. This improves the nutrition of tissues and increases their resistance, which is especially important when transporting victims in the cold season (especially in winter).
It is not recommended to apply a tourniquet on the extremities with an acute surgical infection, or in the event of vascular lesions (arteriosclerosis, thrombophlebitis, etc.), as this may contribute to the spread of the process or the development of embolism.
In addition to the arterial tourniquet, sometimes impose the so-called venous tourniquet with bleeding from large subcutaneous vei. It is superimposed below the site of damage to the vessel with a force that causes compression of only the superficial veins, and for up to 6 hours.
This harness is used for other purposes (blood deposition in the extremities during bleeding, etc.)
Spin (waist). In the absence of a specialized harness, you can use the material at hand, for example, a scarf.
At first it is knotted completely freely, then a stick or plate is inserted into the loop and the scarf is twisted to the necessary degree.
Methods for the final stop of bleeding are divided into four groups:
1) mechanical, 2) thermal, 3) chemical, and 4) biological. For extensive injuries and heavy bleeding, several methods may be required to be applied simultaneously or sequentially in various combinations. In addition, measures are being taken to combat acute anemia (transfusion of blood or blood-substituting solutions, intravenous administration of glucose solutions, isotonic sodium chloride solution, etc.). Often, to stop internal bleeding, they resort to surgery (celiac section, thoracotomy, craniotomy, etc.).